Management of Immune Thrombocytopenia (ITP) . #Idiopathic #Thrombocytopenic #Purpura #Immune #Thrombocytopenia #ITP

Idiopathic Thrombocytopenic Purpura Clinical: • Gingival • Menorrhagia • GI bleeding • Intracranial hemorrhage Management: • Supportive (children) • Platelets (only for severe bleeding or extremely low platelet count) • Corticosteroids • IVIG or anti-D immunoglobulin • Splenectomy #ITP #Idiopathic #Thrombocytopenic #Purpura #Thrombocytopenia #Diagnosis #Overview #Hematology

Algorithm for the outpatient management of thrombocytopenia. (DIC = disseminated intravascular coagulation; EDTA = ethylenediaminetetraacetic acid; HELLP = hemolysis, elevated liver enzymes, and low platelet count; HUS = hemolytic uremic syndrome; ITP = immune thrombocytopenic purpura; TTP = thrombotic thrombocytopenic purpura.) #Diagnosis #Management #PrimaryCare #Outpatient #Thrombocytopenia #AAFP

Causes of Purpura or Easy Bruising in Children Platelet count reduced, i.e. thrombocytopenia - Increased platelet destruction or consumption - Immune - ITP (immune thrombocytopenia) - SLE (systemic lupus erythematosus) - Alloimmune neonatal thrombocytopenia - Non-immune - Haemolytic uraemic syndrome - Thrombotic thrombocytopenic purpura - DIC (disseminated intravascular coagulation) - Congenital heart disease - Giant haemangiomas (Kasabach—Merritt syndrome) - Hypersplenism - Impaired platelet production - Congenital - Fanconi anaemia - Wiskott—Aldrich syndrome - Bernard—Soulier syndrome - Acquired - Aplastic anaemia - Marrow infiltration (e.g. leukaemia) - Drug-induced Platelet count normal - Platelet dysfunction - Congenital - Rare disorders, e.g. Glanzmann thromboasthenia - Acquired - Uraemia, cardiopulmonary bypass Vascular disorders - Congenital - Acquired - Meningococcal and other severe infections - Vasculitis, e.g. Henoch—Schönlein purpura, SLE - Scurvy #Purpura #Bruising #Causes #peds #pediatrics #diagnosis #differential #thrombocytopenia

Drug-Induced Thrombocytopenia The diagnosis of drug-induced thrombocytopenia can be made only by demonstrating resolution of thrombocytopenia once a suspected drug is discontinued.19 It is important to note that many patients with drug-induced thrombocytopenia are initially diagnosed as having idiopathic thrombocytopenic purpura. #Diagnosis #Hematology #Thrombocytopenia #Differential #DrugInduced #Medications #Causes

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Thrombotic Microangiopathy - TTP VS HUS Big picture points : Often hard to differentiate the two entities, but has this distinction has HUGE treatment implications : TTP has high rates of morbidity and mortality, and first-line treatment is plasma exchange. When in doubt, start plasma exchange while awaiting confirmatory testing for TTP #Thrombotic #Microangiopathy #thrombocytopenic #purpura #TTP #HemolyticUremicSyndrome #HUS #thrombocytopenia #Comparison #Diagnosis #Table #Hematology

Treatment of Thrombotic Thrombocytopenic Purpura (TTP) Diagnosis of TTP: • Rare and severe, ADAMTS13 deficiency • Autoimmune >> genetic • Distinguish TTP from other TMA: Thrombotic microangiopathy without other condition (vs. secondary TMA), Platelets < 30 G/L (vs. HUS), Serum creatinine <200 umol/L (vs. HUS) Treatment of TTP: • Consider admission to the ICU (age, LDH, troponin) • Contraindication to platelets transfusion • Daily plasma exchanges (PLEX) +++ • Rituximab (scheduled on day 1, 4, 8 and 15) • Caplacizumab as soon as TTP is diagnosed, in combination with PLEX and RTX • Short-term glucocorticoids • Folic acid supplementation (5-10 mg/day) By Dr. Raphaël Cauchois #TTP Thrombotic #Thrombocytopenic #Purpura #management #treatment #rheumatology #hematology

Differential for the Child with Petechiae or Purpura - Non-thrombocytopenic - Thrombocytopenia #Diagnosis #Peds #Pediatrics #Petechiae #Purpura #Differential #Thrombocytopenia

Thrombocytopenia Work up, differential diagnosis and management. Satyendra Dhar MD, @DharSaty #thrombocytopenia #platelets #ITP #DIC

Algorithm for workup of thrombocytopenia based on observation of the peripheral blood film. TTP/HUS indicates thrombotic thrombocytopenic purpura/hemolytic uremic syndrome. Adapted from:How to approach thrombocytopenia, Hematology 2012, p 193 #Diagnosis #Differential #Algorithm #Thrombocytopenia #Evaluation

Causes of Purpura - Differential Diagnosis Non-PalpabIe → Palpable • Thrombocytopenia (HIT, ITP/HUS), Coagulation defects (DIC, warfarin necrosis), Trauma, Drugs • Vasculopathy - Deposition: Paraproteins, Calciphylaxis • Vasculopathy - Emboli: Septic, Cholesterol • Vasculopathy - HyperC: APLS, PV/ET • Leukocytoclastic Vasculitis (LCV), Immune complex mediated (cryoglobulins, IgA), ANCA associated small vessel BWH Medicine Chiefs @BrighamChiefs #Purpura #nonpalpable #palpable #Causes #Differential #Diagnosis #vasculitis